Provider Demographics
NPI:1881432961
Name:MIKULS, ANDREA CAROLYN
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAROLYN
Last Name:MIKULS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 N 147TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-5129
Mailing Address - Country:US
Mailing Address - Phone:402-916-0325
Mailing Address - Fax:
Practice Address - Street 1:400 S STATE RD STE 220
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1243
Practice Address - Country:US
Practice Address - Phone:610-356-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist